Healthcare Provider Details

I. General information

NPI: 1114673597
Provider Name (Legal Business Name): LOVE & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 23RD ST N
BIRMINGHAM AL
35203-3819
US

IV. Provider business mailing address

208 23RD ST N
BIRMINGHAM AL
35203-3819
US

V. Phone/Fax

Practice location:
  • Phone: 205-774-0605
  • Fax:
Mailing address:
  • Phone: 205-774-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DESTINI LOVE
Title or Position: CEO
Credential: LCSW PIP
Phone: 205-966-3847